Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
PLoS One. 2012;7(7):e41964. doi: 10.1371/journal.pone.0041964. Epub 2012 Jul 27.
Liver stiffness measurement (LSM) and FibroTest (FT) are frequently used as non-invasive alternatives for fibrosis staging to liver biopsy. However, to date, diagnostic performances of Enhanced Liver Fibrosis (ELF) test, which consists of hyaluronic acid, aminoterminal propeptide of procollagen type-III, and tissue inhibitor of matrix metalloproteinases-1, have not been compared to those of LSM and FT in Asian chronic hepatitis B (CHB) patients.
Between June 2010 and November 2011, we prospectively enrolled 170 CHB patients who underwent liver biopsies along with LSM, FT, and ELF. The Batts system was used to assess fibrosis stages.
Areas under receiver operating characteristic curves (AUROCs) to predict significant fibrosis (F≥2), advanced fibrosis (F≥3), and cirrhosis (F = 4) were 0.901, 0.860, and 0.862 for ELF, respectively; 0.937, 0.956, and 0.963 for LSM; and 0.896, 0.921, and 0.881 for FT. AUROCs to predict F≥2 were similar between each other, whereas LSM and FT had better AUROCs than ELF for predicting F≥3 (both p<0.05), and LSM predicted F4 more accurately than ELF (p<0.05). Optimized cutoffs of ELF to maximize sum of sensitivity and specificity were 8.5, 9.4, and 10.1 for F≥2, F≥3, and F = 4, respectively. Using suggested ELF, LSM and FT cutoffs to diagnose F1, F2, F3, and F4, 91 (53.5%), 117 (68.8%), and 110 (64.7%) patients, respectively, were correctly classified according to histological results.
ELF demonstrated considerable diagnostic value in fibrosis staging in Asian CHB patients, especially in predicting F≥2. However, LSM consistently provided better performance for predicting F≥3 and F4.
肝脏硬度测量（LSM）和 FibroTest（FT）常被用作纤维化分期的非侵入性替代方法，以取代肝活检。然而，到目前为止，Enhanced Liver Fibrosis（ELF）检测的诊断性能尚未与亚洲慢性乙型肝炎（CHB）患者的 LSM 和 FT 进行比较，该检测由透明质酸、III 型前胶原氨基末端肽和基质金属蛋白酶组织抑制剂-1 组成。
2010 年 6 月至 2011 年 11 月，我们前瞻性纳入了 170 例接受肝活检的 CHB 患者，同时进行了 LSM、FT 和 ELF 检测。Batts 系统用于评估纤维化分期。
预测显著纤维化（F≥2）、进展性纤维化（F≥3）和肝硬化（F=4）的受试者工作特征曲线下面积（AUROCs）分别为 ELF 的 0.901、0.860 和 0.862；LSM 的 0.937、0.956 和 0.963；FT 的 0.896、0.921 和 0.881。预测 F≥2 的 AUROCs 彼此相似，而 LSM 和 FT 预测 F≥3 的 AUROCs 优于 ELF（均 p<0.05），LSM 预测 F4 比 ELF 更准确（p<0.05）。ELF 预测 F≥2 的最佳截断值为 8.5、9.4 和 10.1，分别用于 F≥3、F≥4。使用建议的 ELF、LSM 和 FT 截断值诊断 F1、F2、F3 和 F4，分别有 91（53.5%）、117（68.8%）和 110（64.7%）名患者根据组织学结果正确分类。
ELF 显示在亚洲 CHB 患者的纤维化分期中具有相当大的诊断价值，特别是在预测 F≥2 方面。然而，LSM 始终能够更好地预测 F≥3 和 F4。
